Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact  M.S. Kristensen, W.H. Teoh, S.S. Rudolph 

Slides:



Advertisements
Similar presentations
Anatomical Terminology & Body Position
Advertisements

Fig 1 Difficult Airway Society difficult intubation guidelines: overview. Difficult Airway Society, 2015, by permission of the Difficult Airway Society.
Jay Smith, MD, Mark-Friedrich B. Hurdle, MD 
Sophie M Graff, Deborah V Wilson, Laurent P Guiot, Nathan C Nelson 
Jade Seguin, MD, Mark Oliver Tessaro, MD  CHEST 
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†   C. Frerk, V.S. Mitchell, A.F. McNarry, C. Mendonca,
M.K. Karmakar, X. Li, A. M.-H. Ho, W.H. Kwok, P.T. Chui 
Ultrasound-guided paravertebral puncture and placement of catheters in human cadavers: an imaging study  C. Luyet, U. Eichenberger, R. Greif, A. Vogt,
More on ramped position and 25-degree head up positions
Endoscopic and Endobronchial Ultrasonography According to the Proposed Lymph Node Map Definition in the Seventh Edition of the Tumor, Node, Metastasis.
Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go?†   C Luyet, G Herrmann, S Ross,
T. Pirotte, F. Veyckemans  British Journal of Anaesthesia 
D. Belavy, M.J. Ruitenberg, R.B. Brijball 
G. Reusz, P. Sarkany, J. Gal, A. Csomos  British Journal of Anaesthesia 
Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq™ laryngoscopes  S.K. Ndoko, R. Amathieu,
What are ultrasound waves:
Physical properties and functional alignment of soft-embalmed Thiel human cadaver when used as a simulator for ultrasound-guided regional anaesthesia 
Block for uniportal video-assisted thoracoscopic surgery: an ultrasound-guided, single- penetration, double-injection approach  Y.-J. Lee, C.-C. Chung,
David E. Hartigan, M. D. , Itay Perets, M. D. , John P. Walsh, M. A
J.-A. Lin, H.-T. Lu  British Journal of Anaesthesia 
M.K. Karmakar, A.M.-H. Ho, X. Li, W.H. Kwok, K. Tsang, W.D. Ngan Kee 
Magnetic resonance imaging study of the in vivo position of the extraglottic airway devices i-gel™ and LMA-Supreme™ in anaesthetized human volunteers 
I.-K. Song, H.-J. Kim, J.-H. Lee, E.-H. Kim, J.-T. Kim, H.-S. Kim 
Trainee anaesthetist diagnosis of intraneural injection—a study comparing B-mode ultrasound with the fusion of B-mode and elastography in the soft embalmed.
Ultrasound-guided infraclavicular brachial plexus block
Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterization in children'a randomized trial 
Preliminary results of a new ultrasound-guided approach to block the sacral plexus: the parasacral parallel shift  T.F. Bendtsen, P.A. Lönnqvist, K.V.
Secondary spread of caudal block as assessed by ultrasonography
Anatomical Position Used when describing positions & relationships of structures in body Assume person is in anatomical position even if body or parts.
Use of a percutaneous puncture needle for true lumen re-entry during subintimal recanalization of the superficial femoral artery  Amr M. Aborahma, MD 
Ultrasound standard of peripheral nerve block for shoulder arthroscopy: a single- penetration double-injection approach targeting the superior trunk and.
Masqueraders of exercise-induced vocal cord dysfunction
Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries    British Journal of Anaesthesia 
Continuing to excel in anaesthesia through the ‘big five’: teaching, training, testing, quality, and research  A.A.J. Van Zundert, S.P. Gatt, R.P. Mahajan 
Jay Smith, MD, Mark-Friedrich B. Hurdle, MD 
Respiratory failure after tracheal extubation in a patient with halo frame cervical spine immobilization—rescue therapy using the Combitube airway  M.
Changing body position alters the location of the spinal cord within the vertebral canal: a magnetic resonance imaging study  M.R.B. Ranger, G.J. Irwin,
Sandhu N.P.S. , Sidhu D.S.   British Journal of Anaesthesia 
Ultrasound standard for lumbar plexus block
Douglas M. Cavaye, FRACS, Rodney A. White, MD, George E
Phaeochromocytoma diagnosed during labour
Emergency surgical airway management in Denmark: a cohort study of patients registered in the Danish Anaesthesia Database  C.V. Rosenstock, A.K.
Displacement of popliteal sciatic nerve catheters after major foot and ankle surgery: a randomized controlled double-blinded magnetic resonance imaging.
Ultrasound-guided central venous catheterization in the prone position
Ultrasound-guided percutaneous tracheal puncture: a computer-tomographic controlled study in cadavers  M. Kleine-Brueggeney, R. Greif, S. Ross, U. Eichenberger,
Ultrasound-guided spermatic cord block for scrotal surgery
H.M.F. Anwer, I.M. Zeitoun, E.A.A. Shehata 
Three-step method for ultrasound-guided central vein catheterization
Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible.
The third ultrasound dimension in anaesthesia and intensive care
Anterior Aortopexy for Tracheomalacia
Structured approach to ultrasound-guided identification of the cricothyroid membrane: a randomized comparison with the palpation method in the morbidly.
J.B. Barbary, F. Remérand, J. Brilhault, M. Laffon, J. Fusciardi 
Giant pseudoaneurysm of the left ventricle
Nasotracheal intubation depth in paediatric patients
Management of a known difficult airway in a morbidly obese patient with gross supraglottic oedema secondary to thyroid disease  M. Hariprasad, G.J. Smurthwaite 
T. Kerforne, M. Chaillan, L. Geraud, O. Mimoz 
Arthroscopy Techniques
T. Saito, S.T.H. Chew, W.L. Liu, K.K. Thinn, T. Asai, L.K. Ti 
Use of a ProSeal™ laryngeal mask airway and a Ravussin cricothyroidotomy needle in the management of laryngeal and subglottic stenosis causing upper airway.
First clinical experience of tracheal intubation with the SensaScope®, a novel steerable semirigid video stylet  Biro P , Bättig U , Henderson J , Seifert.
A.A.J. Van Zundert, B.M.A. Pieters  British Journal of Anaesthesia 
J.T. Kim, S.Y. Jeon, C.S. Kim, S.D. Kim, H.S. Kim 
Ultrasound standard of peripheral nerve block for shoulder arthroscopy: a single- penetration double-injection approach targeting the superior trunk and.
Lung isolation in the morbidly obese patient: a comparison of a left-sided double-lumen tracheal tube with the Arndt® wire-guided blocker  J.H. Campos,
Cricoid pressure force retention analysis using a simulator
P Marhofer, S.C. Kettner, L Hajbok, P Dubsky, E Fleischmann 
M.S. Kristensen, W.H. Teoh  British Journal of Anaesthesia 
David E. Hartigan, M. D. , Itay Perets, M. D. , John P. Walsh, M. A
Use of a percutaneous puncture needle for true lumen re-entry during subintimal recanalization of the superficial femoral artery  Amr M. Aborahma, MD 
Presentation transcript:

Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact  M.S. Kristensen, W.H. Teoh, S.S. Rudolph  British Journal of Anaesthesia  Volume 117, Pages i39-i48 (September 2016) DOI: 10.1093/bja/aew176 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 The transverse (‘Thyroid cartilage–Airline–Cricoid cartilage–Airline=TACA’) method for identification of the cricothyroid membrane. First row: the transducer is placed transversely on the neck where the thyroid cartilage is thought to be until the triangular shape of the thyroid cartilage (=the ‘T’) is identified. Second row: the transducer is moved caudally until the ‘Airline’ (=the ‘A’) is seen; this is the hyperechoic (white) line from the tissue–air border on the luminal side of the cricothyroid membrane. The white line has similar echo lines deep to it; those are reverberation artefacts. Third row: the transducer is moved further caudally until the cricoid cartilage (=the ‘C’) is seen as a black lying ‘C’ with a posterior white lining. The white lining represents the tissue–air border on the luminal side of the anterior part of the cricoid cartilage. Forth row: subsequently, the transducer is moved a few millimetres back in the cephalad direction, and the approximate centre of the ‘Airline’ (=the ‘A’=the cricothyroid membrane) is thus identified and can be marked with a pen. British Journal of Anaesthesia 2016 117, i39-i48DOI: (10.1093/bja/aew176) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 Upper row: step (i) The patient is lying supine, and the operator stands on the patient's right side facing the patient. The sternal bone and the suprasternal notch are palpated, which can be done in even the morbidly obese patient. The linear high-frequency transducer is placed transversely over the neck just cranial to the suprasternal notch, and the trachea is seen in the midline. The middle and the right photographs show the ultrasound image, and the relevant structures are highlighted on the photograph to the right. Blue is the anterior part of a tracheal ring. Yellow indicates the tissue–air boundary inside the trachea. Everything below the tissue–air boundary is artefact. Second row: step (ii) The transducer is slid laterally towards the patient's right side, until the midline of the trachea is at the right border of the transducer, and the corresponding ultrasound image of the trachea (in the right photograph) is truncated into half. Blue is the anterior part of a tracheal ring. Yellows indicate the tissue–air boundary inside the trachea. Third row: step (iii) Staying midline with the right edge of the transducer, the left edge of the transducer is rotated into the sagittal plane to obtain a longitudinal image of the trachea. The anterior parts of the tracheal rings appear as black hypoechoic round structures (like pearls) lying on a strong hyperechoic white line, which is the tissue–air boundary (that looks like a string). Hence, the image is akin to a ‘string of pearls’. The blue markings represent the anterior parts of the tracheal rings. Yellow indicates the tissue–air boundary inside the trachea. Fourth row: step (iv) The transducer is slid cephalad, and the anterior part of the cricoid cartilage (turquoise) is seen as a slightly elongated structure that is significantly larger and more anterior than the tracheal rings (blue). Yellow indicates the tissue–air boundary inside the trachea. Immediately cephalad to the cricoid cartilage is the cricothyroid membrane. The distal part of the thyroid cartilage (purple) is seen. Step (v) The cricothyroid membrane can be pointed out by sliding a needle (used only as a marker) underneath the ultrasonography transducer from the cranial end until it casts a shadow (red line) between the cricoid cartilage (turquoise) and the thyroid cartilage. The green spot represents the reflection from the needle. Care is taken not to touch the patient with the sharp tip of the needle. Step (vi) After this, the transducer is removed, and the needle indicates the mid-level of the cricothyroid membrane. This spot can be marked with a pen so that it remains easily identified should it be needed for subsequent difficult airway management. (The figure in the last row is from Kristensen and colleagues).11 British Journal of Anaesthesia 2016 117, i39-i48DOI: (10.1093/bja/aew176) Copyright © 2016 The Author(s) Terms and Conditions